Why Some Patients Died at Home Due to COVID-19 in a Rural, Tribal Area of India?

Abstract

Introduction: We conducted this study to understand the proportion of deaths that occurred at home and the factors associated with home deaths in a tribal rural area of Gujarat, India. Materials and Methods: We collected a list of all deaths that occurred during the study period from local authorities and triangulated the data. Data collectors (DCs) visited the houses of the deceased person and interviewed the relatives as well as local health-care providers. The DCs categorized each death as COVID-19 or non-COVID-19 death based on the World Health Organization standard definition. For each COVID-19 death, we filled pretested questionnaire (local language) to know the care-seeking behavior of deceased persons. Subsequently, we conducted in-depth interviews of relatives whose family members died of COVID-19 at home (or within 48 hr of admission to a health-care facility) to find reasons for not seeking care at a health-care facility. Results: The risk of home deaths was high among the scheduled tribe population, laborers, below poverty line cardholders, those who did not seek care from private practitioners, those who did not test for COVID-19, those who did not seek care from qualified care providers, and those seeking care to nonqualified care providers. Shortage of health-care facilities, cost of care, and stigma/fear of hospitals were the major factors associated with the care-seeking behavior of patients. Conclusion: The unavailability of critical care, testing facilities, lack of knowledge, high cost of care, and lack of trust in hospitals were the major causes of home deaths among COVID-19 patients.